依那西普对类风湿关节炎患者骨代谢生化指标、骨密度的影响

目的:研究类风湿关节炎患者接受依那西普(etanercept,ETN)治疗52周后血清骨代谢生化指标、骨密度改变。方法:39例患者分为对照组(MTX7.5 mg/周逐渐加量至15 mg/周,3例患者于第8周时最大剂量为20 mg/周);治疗组17例(MTX用法同前,其中2例患者于第8周时最大剂量为20 mg/周,ETN:25 mg,每周2次,皮下注射)。于治疗前、12周、26周、52周分别检测骨保护素(OPG)、血清骨钙素(OC)、降钙素(CT)、甲状腺旁素(iPTH)。并行腰椎及股骨不同部位骨密度(BMD)测定。结果:2组在治疗前血清OPG水平即有显著降低,对照组随着治疗时间的持续而进一步降低。治疗组在治疗26周后出现升高,2组比较有统计学差异(P<0.01);而血清iPTH在治疗前2组均有显著升高,对照组随着治疗时间的持续而进一步升高。治疗组在治疗12周后出现升高,2组比较有统计学差异(P<0.01);2组患者腰椎、股骨颈、股骨沃德三角BMD比较有统计学意义(P<0.01)。结论:应用依那西普治疗类风湿关节炎能减少骨丢失、有效改善患者骨质疏松。

Changes of bone metabolis indicators and bone mineral density in patients of rheumatism arthritis received the treatment of etanercept

OBJECTIVE To investigate the changes of serum bone metabolis indicators and bone mineral density in the patients of rheumatism arthritis after the treatment of etanercept(ETN) and methotrexate plus etanercept(MTX+ETN).METHODS 39 cases of patients were divided into two groups,which were nominated as MTX group and MTX+ETN group.MTX group contained 22 cases,taking MTX only.And the others went to ENT+MTX group taking ENT and MTX treatment.The MTX dose started at 7.5 mg per week.But some patients in two groups could add their dose of MTX to 20 mg per week before week 8.Petients took ENT 25 mg twice a week by subcutaneous injected.At week 0(before thetreatment),12,26,52 weeks some items were tested respectively.The levels of osteoprotegerin(OPG)were tested by enzyme-linked immuno sorbent assaythe.The serum osteocalcin(OC)were tested by Ria method and calcitonin(CT).The thyroid side element(iPTH)were tested by chemiluminescence method.All patients had bone mineral density(BMD) examined.The numerical values above were analysed statistically.RESULTS The levels of OPG in two groups reduced in patients before treatment,and further reduced in MTX group but went up in the patients of MTX+ETN group at week 26.The differences were obviously significant(P<0.01).The iPTH levels rose in two groups and increased more in MTX group.the MTX+ENT group showed OPG rising only at week 12.Also the diversity were significantly marked(P<0.01).The levels of serum calciumphosphorus CT and alkaline phosphatase didn’t showed different in statistics.The lumbar vertebra’neck of femur and femoral ward triangle BMD were checked differently in statistics.CONCLUSION ENT could decrease bone resorption and improve osteoporosis.